Provider Demographics
NPI:1104924794
Name:CHASE, LISA MAUREEN (LICSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MAUREEN
Last Name:CHASE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 1ST ST N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-4058
Mailing Address - Country:US
Mailing Address - Phone:651-278-5370
Mailing Address - Fax:651-351-2757
Practice Address - Street 1:825 NICOLLET MALL
Practice Address - Street 2:MEDICAL ARTS BUILDING, SUITE 1655
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-2606
Practice Address - Country:US
Practice Address - Phone:651-278-5370
Practice Address - Fax:651-351-2757
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical